Monday, July 26, 2004
On Call
I'm on call tonite at JPSH hospital. i've been up since 0800 yesterday. It's now 0220... That's a lot of hours, and I have many more to go before the night is over.
Actually, so far I've really enjoyed my time here at JPSH. I have a really good team - we all get along crazy well and I feel like I've learned a lot. When I first started, I was pretty much clueless about how to manage a patient with almost any complaint when it came to inpatient management. Now, I am seeing patients, writing H&Ps and admission orders and following the patient in the hospital, calling consults, etc. Not too bad for a lowly 3rd year medical student. My team gives me a lot of autonomy as well - that is really cool, since I learn better when I an just thrown out and have to figure it out. Of course, I know that I can get back up if I need it. That's the beauty of being a medical student. I can practice "on my own," but if I need anything, all I have to do is yell.
Tonite has been our slowest call yet. We've only taken 8 or 9 hits (aka admissions). Usually we're pretty close to our max of 15 by now. Of course, the night is still young. We've been hanging out and acting crazy all nite. It's really pretty sad, but it's a REALLY good thing that we don't have any girls on our team - we would so get in trouble... we'd all be out of medicine so fast we'd wonder what hit us. But it's fun being "just us guys."
Tonite, the only patient I've seen is a cardiac patient. He has had 2 MIs in the past as well as a CVA. He was at a convenience store when he began to experience a sharp chest pain in his left chest. This lasted about 2 minutes and resolved without any intervention. He went home and took his ASA and ImDur. he then reported to the ED. He denies any N/V/palpitations/radiation, but he said he was short of breath and lightheaded. Given his extensive cardiovascular history and a significant family history, he was admitted to telemetry to R/O MI. His first set of enzymes were negative and his second is pending.
An interesting thing with this person is that he was hypertensive when he presented to the ED. They gave him some metoprolol IV to try to bring his pressure down and he went into RBBB. This passed after several minutes and he reverted to NSR. Very strange indeed. I've never heard of something like that occuring w/ a Beta Blocker. Too bad I wasn't there to see it. The EKG is pretty impressive, though. The first EKG the ED did has NSR w/ inferior T wave inversions, and then the second shows bigger-than-life RBBB. I'm all like "holy crap! WTF is that?" Very strange indeed.
Another patient we got called on was a consult from OB. This is a 57 y.o. BF in OB for c/o vaginal bleeding for the past 6 weeks and anemia. OB consulted our team because they wanted us to evaluate her for other causes of anemia. First thing that goes through my head is "duh, she's anemic because she's bleeding..." But, of course, it could feasibly be something else. So we go see her. She is very pleasant, but pale. She says that about 6 weeks ago, she began having heavy vaginal bleeding w/ clotting and frequent lower abdominal cramps. She said her LNMP was last july (2003) and she had been amenorrheic since. Suddenly she begain bleeding profusely w/ clots. Shortly thereafter, she began feeling very tired, getting dyspneic w/ minimal exertion and just all around not feeling well. She came to ABC and was admitted and transfused w/ 3 units of PRBCs. They did an ultrasound and found a 16x9cm fibroid tumor in her uterus. They discharged her on hormones and told her to follow up with her OB/Gyn. That was 2 weeks ago. She has not seen her OB/Gyn, nor has she stopped bleeding. She is now symptomatic again and back in the hospital. And Medicine B is on the case.
I see her and there is NOTHING wrong w/ this lady aside from the fact that she is anemic. The only abnormality she has on exam is a f'ing HUGE mass in her suprapubic area. I'm assuming it's this 16x9cm mass in her uterus. It's freaking enormous... 16x9 = ~7x4 inches. That's a big-assed fibroid. And here I'm thinking, "Why are you guys consulting medicine to find another source for this anemia.. you've got a freaking 28 square inch reason RIGHT HERE!!" These people never freaking cease to amaze me.
Anyway, that's all for now. I'll update again later. ¶ 12:35 AM
Actually, so far I've really enjoyed my time here at JPSH. I have a really good team - we all get along crazy well and I feel like I've learned a lot. When I first started, I was pretty much clueless about how to manage a patient with almost any complaint when it came to inpatient management. Now, I am seeing patients, writing H&Ps and admission orders and following the patient in the hospital, calling consults, etc. Not too bad for a lowly 3rd year medical student. My team gives me a lot of autonomy as well - that is really cool, since I learn better when I an just thrown out and have to figure it out. Of course, I know that I can get back up if I need it. That's the beauty of being a medical student. I can practice "on my own," but if I need anything, all I have to do is yell.
Tonite has been our slowest call yet. We've only taken 8 or 9 hits (aka admissions). Usually we're pretty close to our max of 15 by now. Of course, the night is still young. We've been hanging out and acting crazy all nite. It's really pretty sad, but it's a REALLY good thing that we don't have any girls on our team - we would so get in trouble... we'd all be out of medicine so fast we'd wonder what hit us. But it's fun being "just us guys."
Tonite, the only patient I've seen is a cardiac patient. He has had 2 MIs in the past as well as a CVA. He was at a convenience store when he began to experience a sharp chest pain in his left chest. This lasted about 2 minutes and resolved without any intervention. He went home and took his ASA and ImDur. he then reported to the ED. He denies any N/V/palpitations/radiation, but he said he was short of breath and lightheaded. Given his extensive cardiovascular history and a significant family history, he was admitted to telemetry to R/O MI. His first set of enzymes were negative and his second is pending.
An interesting thing with this person is that he was hypertensive when he presented to the ED. They gave him some metoprolol IV to try to bring his pressure down and he went into RBBB. This passed after several minutes and he reverted to NSR. Very strange indeed. I've never heard of something like that occuring w/ a Beta Blocker. Too bad I wasn't there to see it. The EKG is pretty impressive, though. The first EKG the ED did has NSR w/ inferior T wave inversions, and then the second shows bigger-than-life RBBB. I'm all like "holy crap! WTF is that?" Very strange indeed.
Another patient we got called on was a consult from OB. This is a 57 y.o. BF in OB for c/o vaginal bleeding for the past 6 weeks and anemia. OB consulted our team because they wanted us to evaluate her for other causes of anemia. First thing that goes through my head is "duh, she's anemic because she's bleeding..." But, of course, it could feasibly be something else. So we go see her. She is very pleasant, but pale. She says that about 6 weeks ago, she began having heavy vaginal bleeding w/ clotting and frequent lower abdominal cramps. She said her LNMP was last july (2003) and she had been amenorrheic since. Suddenly she begain bleeding profusely w/ clots. Shortly thereafter, she began feeling very tired, getting dyspneic w/ minimal exertion and just all around not feeling well. She came to ABC and was admitted and transfused w/ 3 units of PRBCs. They did an ultrasound and found a 16x9cm fibroid tumor in her uterus. They discharged her on hormones and told her to follow up with her OB/Gyn. That was 2 weeks ago. She has not seen her OB/Gyn, nor has she stopped bleeding. She is now symptomatic again and back in the hospital. And Medicine B is on the case.
I see her and there is NOTHING wrong w/ this lady aside from the fact that she is anemic. The only abnormality she has on exam is a f'ing HUGE mass in her suprapubic area. I'm assuming it's this 16x9cm mass in her uterus. It's freaking enormous... 16x9 = ~7x4 inches. That's a big-assed fibroid. And here I'm thinking, "Why are you guys consulting medicine to find another source for this anemia.. you've got a freaking 28 square inch reason RIGHT HERE!!" These people never freaking cease to amaze me.
Anyway, that's all for now. I'll update again later. ¶ 12:35 AM
